Dallenbach-Hellweg G
Verh Dtsch Ges Pathol. 1991;75:357-62.
Various grades of adenomatous hyperplasia represent precancerous states leading to the most common type of adenocarcinoma with endometrial differentiation. Grades 1 and 2 are characterized by architectural abnormalities only (complex hyperplasia). They rarely progress to carcinoma. Grade 3 in addition is characterized by cytological atypicalities (atypical hyperplasia) and shows a much higher progression rate into invasive carcinoma. Endometrial carcinomas may originate from endometrial glandular epithelium and show endometrial differentiation, or from various types of metaplasias developing in the endometrium from pluripotent Müllerian epithelium. They then show endocervical or serous papillary differentiation. Because of their differences in spread, speed of growth and survival rates, it is important to subclassify these endometrial carcinomas. Immunohistochemically, adenocarcinomas with endometrial differentiation including adenoacanthomas and adenosquamous carcinomas can be recognized by their coexpression of cytokeratin 8 and vimentin, and by their negative reaction for CEA. Distinction from adenocarcinomas with mucinous differentiation, including muceopidermoid adenocarcinomas, is possible by their negative reaction for vimentin and by their positive reaction for CEA. On the other hand, carcinomas with mucinous differentiation primarily located in the endometrium can not be distinguished from those primarily located in the endocervix by immunohistochemistry; that distinction must be made topographically. The same holds true for clear cell carcinomas of both locations. Over the past decade, mucinous adenocarcinomas and clear cell carcinomas originating from the endometrium have increased, whereas adenocarcinomas with endometrial differentiation have become less frequent. This shift is closely related to the altered postmenopausal hormone substitution with the addition of the synthetic gestagens. These apparently stimulate proliferation of endocervical epithelium not only in the endocervix, but also that arising in endocervical metaplasias of the endometrium.
不同级别的腺瘤样增生代表癌前状态，可发展为最常见的具有子宫内膜分化的腺癌类型。1级和2级仅表现为结构异常（复杂性增生），很少进展为癌。3级除结构异常外还具有细胞学非典型性（非典型增生），进展为浸润性癌的几率要高得多。子宫内膜癌可起源于子宫内膜腺上皮并表现出子宫内膜分化，也可起源于子宫内膜中多能苗勒上皮发生的各种化生类型，进而表现为宫颈内膜或浆液性乳头状分化。由于它们在扩散、生长速度和生存率方面存在差异，因此对这些子宫内膜癌进行亚分类很重要。免疫组织化学方面，具有子宫内膜分化的腺癌，包括腺棘皮癌和腺鳞癌，可通过细胞角蛋白8和波形蛋白的共表达以及癌胚抗原（CEA）阴性反应来识别。通过波形蛋白阴性反应和CEA阳性反应可将其与具有黏液分化的腺癌，包括黏液表皮样腺癌区分开来。另一方面，主要位于子宫内膜的黏液性分化癌与主要位于宫颈内膜的黏液性分化癌无法通过免疫组织化学区分，必须从形态学上进行区分。对于这两个部位的透明细胞癌也是如此。在过去十年中，起源于子宫内膜的黏液腺癌和透明细胞癌有所增加，而具有子宫内膜分化的腺癌则变得不那么常见了。这种转变与绝经后激素替代疗法的改变密切相关，即添加了合成孕激素。这些合成孕激素显然不仅刺激宫颈内膜上皮在宫颈内膜的增殖，也刺激在子宫内膜宫颈内膜化生中产生的上皮增殖。
